Hokken-Koelega A C, de Muinck Keizer-Schrama S M, Drop S L
Department of Pediatrics, Sophia Children's Hospital, Erasmus University, Rotterdam, The Netherlands.
J Pediatr Endocrinol. 1994 Apr-Jun;7(2):119-25. doi: 10.1515/jpem.1994.7.2.119.
Growth retardation after renal transplantation (RTx) is generally attributed to prednisone (PDN) administration, although the exact mechanism is poorly understood. In a group of 19 growth-retarded patients after RTx, we studied the effect of alternate-day (group AD, n = 12) and daily (group D, n = 7) PDN treatment on the spontaneous plasma growth hormone (GH) and cortisol profiles, for 48 h in group AD and for 24 h in group D. The maximal plasma GH response to arginine provocation (ATT) and plasma levels of insulin-like growth factor-1 (IGF-1), IGF-2 and serum IGF-binding proteins (IGFBP) were also determined. For both groups the PDN doses were recalculated as daily doses for comparison. The median PDN dose in both groups was similar, 0.15 mg/kg/day, with a range of 0.10-0.25 mg/kg/day. Glomerular filtration rate (GFR) was above 20 ml/min/1.73 m2 in all patients. We hypothesized that alternate-day PDN therapy and even more so daily PDN therapy would have a deleterious effect on GH and cortisol secretion and would result in lower GH-dependent growth factors as compared to control data of healthy children. Our findings revealed that growth-retarded renal allograft patients, receiving either alternate-day or daily PDN therapy, have significantly lower mean plasma GH levels than controls, but normal diurnal rhythm of GH and cortisol secretion as well as normal immunoreactive IGF-1 and -2 levels. Mean serum IGFBP-1 levels were normal, but mean serum IGFBP-3 levels were significantly increased, while a significant negative correlation was found between the GFR and serum IGFBP-3 levels.(ABSTRACT TRUNCATED AT 250 WORDS)
肾移植（RTx）后生长发育迟缓通常归因于泼尼松（PDN）的使用，尽管其确切机制尚不清楚。在一组19例RTx后生长发育迟缓的患者中，我们研究了隔日（AD组，n = 12）和每日（D组，n = 7）PDN治疗对自发性血浆生长激素（GH）和皮质醇水平的影响，AD组观察48小时，D组观察24小时。还测定了对精氨酸激发试验（ATT）的最大血浆GH反应以及胰岛素样生长因子-1（IGF-1）、IGF-2的血浆水平和血清IGF结合蛋白（IGFBP）。两组的PDN剂量均重新计算为每日剂量以作比较。两组的PDN剂量中位数相似，为0.15mg/kg/天，范围为0.10 - 0.25mg/kg/天。所有患者的肾小球滤过率（GFR）均高于20ml/min/1.73m²。我们假设隔日PDN治疗甚至每日PDN治疗会对GH和皮质醇分泌产生有害影响，并且与健康儿童的对照数据相比，会导致GH依赖性生长因子水平降低。我们的研究结果显示，接受隔日或每日PDN治疗的生长发育迟缓的肾移植患者，其平均血浆GH水平明显低于对照组，但GH和皮质醇分泌的昼夜节律正常，免疫反应性IGF-1和 -2水平也正常。平均血清IGFBP-1水平正常，但平均血清IGFBP-3水平显著升高，并且GFR与血清IGFBP-3水平之间存在显著负相关。（摘要截断于250字）
